Future of Rectal Cancer Treatment: Personalized Medicine and Minimally Invasive Surgery

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• Personalized Medicine is the Future
• Molecular Markers for Prognosis
• Rise of Minimally Invasive Surgery
• The Multidisciplinary Team is Essential
• Importance of High-Volume Surgical Centers
• The Evolving Patient Role in Care
• Seeking the Best Rectal Cancer Treatment

Personalized Medicine is the Future

Dr. Torbjorn Holm, MD, states that the core future trend in rectal cancer treatment is a shift towards personalized medicine. This means treatment plans will be meticulously tailored to the individual patient rather than following a one-size-fits-all approach. This evolution is driven by better diagnostics and a deeper understanding of tumor biology.

Molecular Markers for Prognosis

A key advancement will be the routine use of molecular markers from tumor biopsies. Dr. Torbjorn Holm, MD, explains that analyzing a tumor's genetic pattern will allow doctors to predict a patient's prognosis with high accuracy. This precision medicine approach will identify which patients have a very low risk of metastasis and which have a high risk. Consequently, treatment can be optimized; some patients may safely avoid radiation therapy or chemotherapy, while others will receive more intensive regimens.

Rise of Minimally Invasive Surgery

Dr. Torbjorn Holm, MD, highlights that minimally invasive surgical procedures for rectal cancer are becoming much more common. Techniques like laparoscopic and robotic surgery are increasing rapidly. He specifically notes the adoption of a new method called transanal total mesorectal excision (taTME), which is gaining traction quickly. These approaches typically offer patients benefits like less pain, shorter hospital stays, and faster recovery.

The Multidisciplinary Team is Essential

Dr. Anton Titov, MD, and Dr. Holm agree that discussing every rectal cancer patient in a multidisciplinary team (MD T) meeting is non-negotiable for modern care. This team of surgeons, oncologists, radiologists, and pathologists reviews cases before and after surgery to make collective decisions on the need for additional treatment like chemotherapy and to plan appropriate, risk-stratified follow-up schedules.

Importance of High-Volume Surgical Centers

Due to the complexity of modern rectal cancer care, Dr. Torbjorn Holm, MD, emphasizes that treatment must be centralized in high-volume hospitals. Surgeons at these centers perform these complex procedures frequently, which is directly linked to better patient outcomes and lower complication rates. This centralization ensures that patients are treated by very well-educated and highly experienced medical teams.

The Evolving Patient Role in Care

A significant shift, according to Dr. Holm, is the move towards patients becoming informed consumers of healthcare. Patients are now more educated, using the internet and open cancer registries to research their condition and seek out highly-ranked hospitals with the best results. Dr. Holm believes patients should demand high-quality treatment and have the power to decide who treats them, a change from the traditional model where the doctor made that choice.

Seeking the Best Rectal Cancer Treatment

Dr. Anton Titov, MD, often discusses the critical importance of obtaining a medical second opinion for complex conditions like rectal cancer. This process confirms the diagnosis and treatment plan, ensuring a patient is on the best possible path. Dr. Holm's insights reinforce that finding the best rectal cancer treatment center and surgeon is a proactive step every patient should take to achieve optimal outcomes through advanced, personalized care.

Full Transcript

Dr. Anton Titov, MD: Dr. Holm, you have more than forty years of experience treating rectal cancer patients in very difficult situations. You have achieved international authority status globally on rectal cancer treatment.

Dr. Anton Titov, MD: What is the future for rectal cancer treatment? What kind of advances can rectal cancer patients hope for in the next several years?

Dr. Torbjorn Holm, MD: It is a good and also very difficult question. I think we're living in a time where we have more and more focus on personalized medicine. That means that rectal cancer treatment must be tailored to the individual patient.

I think rectal cancer patients are getting more and more aware of how cancer should be treated. Rectal cancer patients are on the internet; they read a lot. We also have cancer patients' registries in many countries. There is quality scoring of the hospitals.

So many rectal cancer patients will seek treatment in hospitals that are highly ranked for good skills. I think that is one important future trend in rectal cancer treatment. The patient will demand high quality treatment much more than today.

I mean today or in the past, patients had just gone to the local hospital, met their doctor, and trusted that doctor. In the future, patients would be much more aware, much more educated. Patients would seek treatment in the hospital for the best results, I am sure.

Also, for the individual rectal cancer patients, we will have molecular markers in the near future. Tumor markers will predict rectal cancer prognosis with high accuracy. So in the near future, we will predict prognosis for rectal cancer patients from biopsies.

We will see what kind of genetic pattern the rectal cancer tumor has. We will be able to tailor the treatment for rectal cancer much better. Some rectal cancer patients may not benefit from radiation therapy. Some rectal cancer patients may not benefit from chemotherapy.

Some patients with rectal cancer have a very low risk of metastasis. Other rectal cancer patients have a high risk of metastases. We will predict that much better just by multiple molecular markers in the future.

Also, I think minimally invasive procedures for rectal cancer treatment will be much more common than they are today. We can already see that minimally invasive surgery for rectal cancer treatment is increasing very rapidly. Now with the new robotic surgery, more patients have minimally invasive surgery to treat rectal cancer.

Recently, a new method of transanal total mesorectal excision of rectal cancer has been launched. This surgery method is now taking over quickly. In one way, treatment of rectal cancer has become more and more complex today. There are so many options and so many possibilities in treatment of rectal cancer.

We have to tailor the treatment for each individual patient. That means that to deal with patients with rectal cancer, you have to be very, very well educated. Again, that means that you have to centralize treatment in hospitals with high volumes, where doctors know how to treat rectal cancer well.

This is the future of rectal cancer treatment: high-volume surgical departments, well-educated patients, individualized treatments based on molecular assessments, and then more minimally invasive surgery. That is the summary of future trends in rectal cancer treatment.

Dr. Anton Titov, MD: Clearly these are recurring themes in cancer treatment. It requires multidisciplinary treatment teams and high volume surgical procedures.

Dr. Anton Titov, MD: For best treatment results, a cancer surgeon has to have high-volume surgery in that particular type of surgical operation that has to be done on the patient. These are recurring themes that come up in our conversations across various medical and surgical specialties.

Dr. Torbjorn Holm, MD: Today you should not be allowed to treat patients with rectal cancer unless you discuss them in the multidisciplinary team meeting before and even after surgery. So the decision can be taken: does the rectal cancer patient need more treatment? How should the patient be followed up?

It's obvious that some patients with rectal cancer have a very low risk of recurrence. Maybe you don't have to follow them at all. Some rectal cancer patients have a high risk of cancer recurrence; they should be followed very intensively.

All of these things would be much more demanding in the future. That's why you need the multidisciplinary treatment teams. That's why you need the high volume surgical units to treat patients with rectal cancer.

Dr. Anton Titov, MD: There is also initiative and activity by the patients seeking the correct treatment. Patients should understand the value of going to the best cancer surgeon. That surgeon must have the most experience in doing the correct surgery.

Dr. Torbjorn Holm, MD: Then we have obstacles to best treatment of rectal cancer. Because at least in the Swedish health system, there is no free market. So the patient cannot go to any hospital they want to go to.

The government decides how many operations each hospital is allowed to do every year. This is a problem. But hopefully the demand by patients will solve that in the future. So that if the rectal cancer patient wants to go to a hospital, then the government will pay for it.

So that hospital will increase their workload. Hospitals that are not so popular will have to close down. I hope that will be the future. The availability of treatment has to be tailored to the patient's needs.

It should be the patients who decide who should treat them. Not the way it has been to date, when doctors decide who should treat the patient.

Dr. Anton Titov, MD: So patients should become true consumers of health care. For some reason, the term "client" or "consumer" has had negative connotations in medicine. That's absolutely not true. Because "patient" means somebody who patiently awaits. That's not the way medicine is going.

Dr. Torbjorn Holm, MD: Future will be completely different. Patients will demand a lot of information; they will demand to come to special treatment units. Patients will demand to have the best possible treatment.

Patients will find out about best treatment options on the Internet and in the open registries. That would be the future.

Dr. Anton Titov, MD: Professor Holm, thank you very much for this very informative conversation. It's a very exciting area of oncology.

Dr. Anton Titov, MD: Rectal cancer is a difficult problem, but so much has been achieved. In our conversation today, it is clear a lot more will be achieved in the future. Thank you very much!

Dr. Torbjorn Holm, MD: Thank you!